You struggle with your mental health and a nearby cafe offers a lifeline — then it suddenly closes

There was little consultation or warning. One Friday in late January, a manager from Greater Manchester’s mental health services walked into No.93 Wellbeing Centre, in Harpurhey, and found Lauren Gregory. 

Gregory first visited the centre — a community hub tailored to people with mental health issues — in the midst of the first lockdown after the birth of her daughter. “I had a very traumatic delivery, my daughter went back into hospital.” She was already accessing mental health services at the time and was put under the perinatal team, who support new mothers, before visiting the centre.

But once restrictions came into place it became harder to get appointments and help. “Everything was pulled,” she remembers. “For a year, I was at home suffering and ended up with quite a serious diagnosis of complex PTSD. I’d go to mum and baby groups and I’d be a nervous wreck.” She would worry about how put together the other mothers appeared, how they didn’t seem to be struggling like her.

She started to feel suicidal, and like her daughter didn’t need her. She visited No.93’s Crisis Cafe, a service designed as an alternative to A&E where people struggling with suicidal thoughts, panic attacks, or other mental health crises can come to chat to a professional in a more relaxed setting. 

Following treatment for her PTSD, Gregory continued visiting the centre and its cafe socially, and someone suggested she run a group for people with similar experiences to her own. And so she started a mindfulness group for new mothers, many of whom she met in the No.93 cafe, at her daughter’s school in north Manchester, or sometimes just in Asda. 

The cafe, she says, is the gateway to the other services the centre provides. More than that, in an age in which opportunities for in-person connection have been all but eradicated — supermarket tills swapped for self checkouts, librarians replaced by machines allowing you to scan your own books — it’s somewhere isolated people can ease their sense of loneliness. And, it’s a place where those without much spare cash can afford a cheap hot meal. 

That’s why when the mental health manager walked into the centre, up to Gregory, and asked “how’s the cafe?” Gregory replied “great, thank you.” This person had never been in the centre before, or visited the cafe, but proceeded to call a meeting with the centre’s managers. They said the cafe’s three staff would be having their contracts terminated, and that the cafe would be closed within a week. There was no money for it anymore.

‘It’s so frustrating, because no one’s been consulted about it’

Greater Manchester’s health services are devolved. This means that the region’s Integrated Care Board (ICB) decides which services receive money, and how much they receive. A simplified flow chart would follow the money from central government to the ICB and then into Greater Manchester’s various NHS foundation trusts and their services. Ultimately, if a service in Greater Manchester’s NHS needs money, the ICB holds the purse strings. 

But just as the trusts are beholden to the ICB, the ICB is beholden to the government. And the ICB is running out of money. Last year it was found to have overspent by some £50m, and at a board meeting last month, members were warned of the difficult decisions that would need to be made on what services to cut to stop the ICB from going further into the red. 

These could be services of “limited clinical value,” or ones the ICB decides do not provide enough return on investment. Decisions like these are incredibly difficult. Especially now when there are so few services both in the NHS and funded by the NHS in communities that can truly be called non-vital. But while the books have to balance, the story of No.93’s cafe highlights the effect that seemingly small, anodyne cuts to funding can have.

Greater Manchester Mental Health Trust took over the cafe last July. It was previously managed by a social enterprise called Healthy Me Healthy Communities, which handed it over to the trust after running the cafe for about five years. The trust now subsidises the cafe with money allocated by the ICB, giving it an annual budget of £37,500. 

In the grand scheme of the millions the ICB has overspent, and the millions more it needs to recoup, pulling a cafe costing £37,500 a year seems miserly. However, the trust ended up subsidising the cafe by a further £40,000 (more on this later), making the actual figure £77,500 — not exactly pocket change, but still a very small fraction of the savings the trust needs to make.

A spokesperson for the ICB said: “We appreciate the cafe’s significance, particularly in reducing social isolation and creating a supportive, safe space,” and explained that the board is working with the trust to find a sustainable, long-term solution. “As with all NHS funding, this must go through the formal annual budget-setting process, which is still underway.” Their response also stressed that a charity, Feed the City, is still coming in two days a week to serve free meals in the cafe space, and that the Crisis Cafe service, which runs out-of-hours and is designed for emergencies, not daily socialising, continues to function as usual.

The decision, based on background conversations, has more to do with the cafe’s previous provider pulling out at short notice, leaving the trust to plug the gap, and then the cost quickly outstripping what the ICB allocated. However Rich Browning, the CEO of the previous provider — Healthy Me, Healthy Communities – disputes this: “we gave them three months notice.”

But from the perspective of the No.93 users, the cafe’s funding being pulled isn’t necessarily what’s most insulting. It’s that they weren’t consulted on, or warned about, the impending closure. “It’s so frustrating,” says Hannah, a volunteer at No.93, “because no one’s been consulted about it.” It’s late February and we’re sitting in one of the side rooms at No.93, where Laura hosts her mothers’ group.

At that point, the trust wanted to consult with its users and staff within a few weeks. But what’s the use of consultation after the fact? Volunteers had already seen attendance to their workshops drop. Gregory says her mothers’ group has “imploded” as fewer women have come to the centre now they know the cafe is shut. What she and the others wanted was for people from the trust and ICB to come to a public meeting hosted in Harpurhey by those who use the centre — and for those people to come and hear them out before the cafe closed, not after. I sent the trust multiple questions about whether a consultation was carried out, and for more information on the rationale behind the closure, but it did not respond by the time of publication.

Feeling forgotten

A few weeks after meeting Gregory, I arrive at the meeting at Harpurhey Neighbourhood Project, another community centre in the area that hosts knitting workshops, tai chi classes, and meetings of the Greater Manchester Tenants Union. Chairing the meeting is Karen Reissman, a former mental health nurse.

Among the attendees are other activists and volunteers who feel the region’s mental health services are on the decline, including Dr John Mulligan, a clinical psychologist at the trust currently on strike over staffing, and Annabel Marsh, another former nurse who runs a patients group in Burnage that started out helping people struggling to access mental health services but now also serves two hot meals a week for those struggling to find the money to eat. She receives no funding from the trust. 

Members of the trust leadership, as well as the ICB board of commissioners including former leader of Manchester City Council Richard Leese, were invited to the meeting at Harpurhey Neighbourhood Project. None showed. 

After Reissman finishes her opening remarks, users of the cafe begin to share their stories. “The cafe allows people to connect with each other, regardless of the service they originally went in for,” says Cathy, who runs an exercise group at the centre. “At the end of last year, I was in an abusive relationship and No.93 saved my life. I went to the Crisis Cafe and got help with my mental health,” says Anna, who begins to cry talking about the centre and the cafe. Pat Karney, the area’s local councillor, said: “[the ICB] see the word ‘cafe’, and they think it’s a Greggs or something. They have no idea, because they’ve not heard from the people today, what this cafe means, and what it means to the people who use the centre.”

One man, named Nick, is visibly nervous to speak to the room. “At home, I had moments when I was really struggling with the thoughts inside my head, the emotions inside my head, that were pushing me to take my own life.” He has been under mental health services since 2011 and looks maybe 35. “I was bullied throughout school and suffered trauma in childhood and in adulthood. And the cafe is one of the very few places where I have felt seen, heard, supported, cared for and actually treated like an actual human being.”

But it seems like none of those stories reached the people at the top. It wasn’t until yesterday, in the cafe space at No.93, that the members of the trust and the ICB visited to consult with the cafe’s customers. By that time Nick, who was asked to come specifically to talk about how the cafe had helped him, had been hospitalised. 

The trust representative told the crowd that the cafe had overspent on its £37,500 budget — “that’s not even half a manager’s salary in the trust!” called out Marsh, from the Burnage patients’ group. When asked how much the cafe had overspent, the trust representative said she didn’t know, and had to go out of the meeting to make a call to find out. 

Juliet Edie, one of the ICB commissioners, said she had been meeting with the board’s procurement team about finding a new provider to run the cafe. But people were still more angry about how they had been left in the dark about the cafe’s financial situation, then had it pulled from under them. 

Edie and her trust colleague, once back from her call, became avatars of the system many felt had forgotten about them, or otherwise didn’t think they mattered. “We don’t want to come here and shout and be angry,” said one long-term volunteer named Andrea. “But we have to be for the others that can’t! The others that aren’t here.”

It transpired that the cafe, in the space of about nine months, had overspent on its budget by £40,000. The trust approached the ICB for more money to help subsidize it, but the ICB could not afford to. “You’ve used that word overspend, which I know gets used a lot,” says Mulligan, the psychologist on strike. “But it’s really under investment.”

“Yes,” Edie, the commissioner, agrees.

“We’ve not actually invested in stuff that we actually need,” Mulligan adds.

The trust representative tried to assure the meeting that the cafe had only been paused while the commissioners look at alternatives. But it doesn’t feel that way in practice. It doesn’t feel that way to the three women who worked in the cafe and have now lost that income. And it doesn’t feel that way to the people who now sit at home instead of coming to the cafe. 

“This is on my care plan,” Debby tells me, after the meeting concludes. Diagnosed with paranoid schizophrenia, her psychiatrist recommended the cafe. And now, the same trust that employs the psychiatrist has closed it. “It’s all stressing me out,” she says. “I’ve done exactly what they’ve told me to do” in visiting the cafe regularly, meeting new people, joining clubs and engaging with the other services. But now it feels like it’s being taken away. “You can’t miss something unless you’ve had it,” Debby says. “And I’ve had it, and I will miss it.”